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Assessing bimanual performance in young children with hemiplegic cerebral palsy: a systematic review
Susan Greaves1, Christine Imms, Karen Dodd
1La Trobe University, Royal Children's Hospital, Melbourne, Australia.
Insights
Few tools effectively assess bimanual skills in young children with hemiplegic cerebral palsy. The Assisting Hand Assessment is the only tool with proven reliability and validity for this population.
Area of Science:
- Pediatric Rehabilitation
- Neurodevelopmental Disorders
- Motor Skill Acquisition
Background:
- Hemiplegic cerebral palsy (CP) significantly impacts bimanual skill development in young children.
- Early and accurate assessment is crucial for effective intervention in pediatric CP.
- Limited validated tools exist for evaluating bimanual abilities in this specific age group.
Purpose of the Study:
- To systematically review available assessment tools for bimanual skills in children aged 3 years and younger with hemiplegic CP.
- To evaluate the evidence for validity, reliability, and clinical utility of identified assessment instruments.
- To identify gaps in current assessment methodologies for this population.
Main Methods:
- A comprehensive search of 10 electronic databases and grey literature was conducted (1806-2009).
- Inclusion criteria focused on child's age, diagnosis of hemiplegic CP, and discrete bimanual assessment.
- Psychometric properties (validity, reliability) of identified assessments were critically appraised.
Main Results:
- Out of 1435 retrieved papers, 15 met the inclusion criteria.
- Eleven distinct assessments of bimanual performance were identified.
- Only the Assisting Hand Assessment demonstrated adequate evidence of reliability and validity for its intended use; ten others had insufficient psychometric support.
Conclusions:
- Reliability and validity are paramount when selecting or developing assessments for young children with hemiplegic CP.
- Standardized administration, scoring, and age-appropriate items are essential for accurate bimanual skill evaluation.
- A validated assessment for younger infants is critically needed to guide early intervention during periods of rapid brain development.
Aim:
This systematic review investigated the availability of assessment tools to evaluate bimanual skills in young children (< or = 3y) with hemiplegic cerebral palsy. Evidence for validity, reliability, and clinical utility of the identified instruments was sought.
Method:
Ten electronic databases and grey literature were searched (earliest 1806) to February 2009 to identify articles that met criteria related to the child's age and diagnosis, and included a discrete bimanual assessment. Further searches for evidence of psychometric properties of each identified assessment were undertaken. For quality criteria, we evaluated the internal validity of each study and appraised the validity and reliability of identified assessments.
Results:
From 1435 papers retrieved, 15 were eligible for inclusion, and 11 assessments of bimanual performance were identified. Ten assessments had inadequate evidence for reliability and validity. Only the Assisting Hand Assessment had evidence for reliability and validity for its intended purposes.
Interpretation:
Reliability and validity are fundamental considerations when developing or selecting assessments. Additional considerations for assessing young children include the following: (1) standardized administration and scoring; (2) items that capture the complexity of bimanual behaviour; and (3) protocols and items targeted within a small age range to meet specific developmental needs. A validated assessment of younger infants is needed to support early intervention during this period of rapid brain development.
